- Humana (Atlanta, GA)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- CVS Health (Atlanta, GA)
- …procedures/services or initiate a Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to ... be required. This position will be remote working from home anywhere in the US. **Position Summary** + Utilizes...3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management… more
- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Sharecare (Atlanta, GA)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...minimum. + This position will be based in a home office which must satisfy all HIPAA requirements. Sharecare… more
- Humana (Atlanta, GA)
- …action. + Live in NC, SC, FL or GA + 2 or more years of Utilization Management (UM), Pre-Auth, and/or other managed care review experience + 1 or more ... internal stakeholders for review depending on case findings. Educates providers on utilization and medical management processes. + Enters and maintains pertinent… more
- CVS Health (Atlanta, GA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... day. **Position Summary** **This is a remote work from home role anywhere in the US with virtual training.**...Obstetrics experience . **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- Molina Healthcare (Atlanta, GA)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Prime Therapeutics (Atlanta, GA)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing criteria. + At ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse Sr- REMOTE **Job Description** Under supervision, is responsible for performing… more
- CVS Health (Atlanta, GA)
- …You can have life-changing impact on our members, who are enrolled in Care Management and present with a wide range of complex health and social challenges. With ... exciting opportunity as we grow and expand our Care Management Programs to change lives in new markets across...community. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department … more